BERNE — Patients in the Hilltowns are wondering where they will go for medical care after learning that a decades-old doctor’s office, now known as CapitalCare Family Medicine Berne, will be closing.

Joan Hayner, chief operating officer for Community Care Physicians, P.C. — the company that owns the practice — confirmed on Wednesday that the office will be closing at the end of June.

The closure is because Kristin Mack, O.D., a doctor of osteopathy and the only physician at the practice, is leaving in mid-June, said Hayner.

Mack wrote in an email to The Enterprise on Wednesday that she will be working at Hudson Headwaters Health Network in Ticonderoga, in Essex County.

While Mack informed the company long before her departure, Hayner said that Community Care Physicians had been searching up until last week and was unable to find another doctor to take on the practice, or even another organization to take it on.

Rather than wait any longer and risk leaving patients without a doctor, Hayner said, the company decided to close the practice and have patients transfer to another location as soon as possible.

“We have exhausted many different avenues,” she said.

The practice has around 1,900 active patients, meaning that they have visited the office within the last two or three years, said Hayner.

“It’s a relatively small practice,” she said.

“Everybody I talk to is just devastated,” said Susan Hawkes-Teeter, a patient at the practice.

Hawkes-Teeter has lived in Berne since 1983. During this time, she has had only three primary doctors. The first was Margery Smith, M.D. who practiced from the East Berne home she shared with her husband, Harry Garry, a farmer; both are now deceased.

Smith was later assisted by Gary Kolanchick, M.D. who went on to start his own practice in the Berne hamlet that he ran for over 30 years. When Kolanchik retired in 2015, Mack stepped in, working with him for a year before he retired.

“I know everyone shares in my sadness for the end of an era of excellent care in the Hilltowns by Drs. Smith, Perkins, and Kolanchick,” Mack wrote, referencing Westerlo’s pioneering doctor, Anna Perkins. “It was an honor to be a part of that legacy. My hope is that the health system is already starting to change for the better and will quickly get back to allowing independent, strong, rural communities access to great healthcare.”

She added that she believed community members would be the ones banding together and finding a solution.

“What my patients have taught me is that there’s more to health than prescriptions and office visits — there are relationships, community events, and support from neighbors and familiar faces that make huge impacts on health. This community has all of that and so I am confident that will be appreciated by the right people in the future,” she wrote.

Kolanchick still owns the building on Helderberg Trail in Berne, directly next to the schools, that housed his practice and was then used by Mack. He could not be reached before press time to comment on the future of the building.

While Kolanchick was in the process of finding his replacement, he sold his practice to CapitalCare Medical Group. In 2017, CapitalCare merged with Community Care Physicians. The company now has around 75 different offices, with locations including Rotterdam, Ravena, Guilderland, and Slingerlands.

“Doctor in the Hilltowns”

“It was so wonderful knowing there was a doctor in the Hilltowns,” said Hawkes-Teeter. The transition between each doctor was smooth, she said, and was like attending “basically the same practice.”

The closest practices run by Community Care Physicians are in Guilderland and in Slingerlands, said Hayner. The practices are each a 25- or 30-minute drive from the Berne hamlet.

Hayner said both practices will have the capacity to take on the extra patients. Patients have a choice to go elsewhere, but Hayner claimed the process would be more seamless for patients if they stayed within the Community Care Physicians network. The company cannot transfer records without patient authorization, so Hayner encourages patients to take action as soon as possible.

Hawkes-Teeter lives within walking distance of the Berne practice, and says that it is important to have a medical practice nearby if care is needed right away. The practice has functioned almost like an urgent-care center where she has been able to be treated quickly for things like urinary-tract infections or tick bites, Hawkes-Teeter said.

She recalled in tears how, after a dog attack, she was cared for by a nurse who she knew well. “It would have been very hard to have gone … somewhere off the Hill,” she said.

Hawkes-Teeter said she has no idea where she will go for medical care now that the practice is closing. It would take her at least half an hour to drive to somewhere like Guilderland, Rotterdam, or Slingerlands, she said, and she noted that someone older may not be able to drive. She also will miss going to a smaller practice.

“I just think that it gives them a fuller picture of who you are,” she said.

She wonders why the practice cannot bring in another doctor, even temporarily, to keep the practice running, saying that it has to make some amount of money to keep it open.

“I think it’s just easier for them to close down … ,” she said. “I can’t imagine that they are losing money.”

Hayner declined to comment on whether an economic impact was considered when deciding to close, but she said the biggest factor in the decision was losing their sole physician.

Hawkes-Teeter said that Mack has made a point to connect with the community, attending local fundraisers and working with the Berne-Knox-Westerlo school district.

Hayner said that the school district has a contract with Community Care Physicians and that this will remain in place; doctors at the Slingerlands office will work with the school instead, she said.

Vitalists

Last October, the practice began a new program, employing “vitalists” to perform home visits with Mack or one of her staff communicating with patients by webcam.

Hayner said that Community Care Physicians intends to continue the vitalist program out of its Slingerlands practice and possibly even expand it.

“We’re very excited about that program,” she said.

One of the vitalists, Ray Schimmer, said on Tuesday that there are about a dozen emergency medical technicians like himself — he is also an emergency medical technician on the Helderberg Ambulance squad — who serve as vitalists in the program. They mainly serve people who are homebound and unable to come to Mack’s office — let alone drive half an hour elsewhere.

“I just don’t know what’s going to happen to these people,” said Schimmer.

“The consequences, particularly for the elderly, are going to be catastrophic,” he told The Enterprise. “I think people will die up here if this goes through.”

Schimmer said he has contacted local politicians and the state and county health departments. He is now trying to reach the board of directors at Community Care to see if it can reverse its decision.

Schimmer said on Thursday that vitalists have to arrive at the doctor’s office in Berne before they see a patient in order to pick up equipment and the patient’s information. After the appointment they return to the office to have a “mini-conference” with the doctor or physician’s assistant about the patient.

“If it’s going to be in Slingerlands, that’s another matter,” he said, later adding he likely wouldn’t continue working as a vitalist if that’s the case, but said he could not speak for the other vitalists, all of whom currently live in the Hilltowns.

Where the vitalists travel can range from places as far as Schoharie County or Delmar, where patients from Berne may have moved, to a few miles away, said Schimmer.

The vitalists will check a patient’s vital signs, use a stethoscope that transmits the audio to the doctor, and have the doctor video chat with the patient. The vitalist may also check in with the patient’s family, said Schimmer.

He recalled taking back issues of The Altamont Enterprise and a newsletter from the school district to one patient because she felt so disconnected from the community by being homebound. He is not sure what would replace the program were it to be discontinued.

Hayner said that patients at the Berne practice have already been visiting offices outside the Hilltowns such as for seeing specialists or even picking up a prescription at the grocery store. She added that, when Kolanchik left, some of his patients went to other practices like the Slingerlands office.

“We’re already caring for our patients ‘on the Hill,’ as they say,” she said.

Outside of the vitalist program, many of Community Care Physicians practices also already perform home visits, she said, in addition to having “care managers” staffed to help patients come in for appointments.

“We do have mechanisms to help these patients,” she said.

Westerlo doctor

The nearby Hilltown of Westerlo found itself in a similar predicament 11 years ago. St. Peter’s Hospital had run a clinic in Westerlo after Anna Perkins, M.D., a revered rural physician, died in 1993 and left her home and clinic to serve as a doctor’s office.  The hospital closed the clinic in February 2008, saying that the center was losing money and the number of patients had been dwindling.

The Westerlo community formed a committee to find a doctor to live in Perkins’s house and use her office to keep the practice running; Myria Emeny, M.D. was a good fit.

Emeny was not deterred by St. Peter’s findings. “Their numbers were dwindling in terms of their goal was 25 patients per day,” Emeny said at the time.  “They were only getting 11 to 15. My goal is no more than 12 per day.”

Because the clinic had a full-time nurse and secretary, it needed bigger numbers to pay for overhead, Emeny said.

Emeny runs a “micro-practice” from her home in Westerlo. In micro practices, doctors lower overhead costs by also performing the roles of secretary, cashier, nurse, groundskeeper, and janitor.  Patients make appointments through the internet.

“I went into medicine to serve underserved populations, and rural areas are underserved,” said Emeny in 2008 when she opened her Westerlo practice.  “Coming here stays within my own ethics of giving back.”

She said this week that she heard about the closing of the Berne practice when someone called and asked if she was taking new patients, which she said she is.

“It’s going to affect the seniors more than anybody else,” she said of the Berne office closing.

Emeny’s concerns are that patients will not keep regular doctors’ appointments anymore, particularly if they are traveling to an office outside the Hilltowns. Emeny also conducts home visits for patients who become less mobile for this reason.

Without regular visits, patients can develop debilitating conditions that could otherwise be prevented, like types of cancer or paralysis from a stroke, said Emeny. She added that it can also be problematic to keep the same prescription for years without a doctor monitoring it, recalling one patient who came to her practice who had been taking the same medication and had not seen a doctor for seven years.

“Preventative care is high on my list,” she said.

Sometimes patients don’t come to her for years not because of a lack of mobility or accessibility, but simply because their health-insurance deductible is so high. Emeny said that some patients have gotten rid of their insurance because it is cheaper to pay for her fees out-of-pocket than to pay for insurance with such a high deductible that they never use the benefit.

She does not recommend this because it means there is no insurance to cover the cost of a catastrophic accident.

She emphasized again that patients should not stop seeking medical care in light of the closure.

“That medical care is important,” she said.